Identification, Prevention, and Treatment of Perinatal Depression in Low- and Middle-Income Countries: A Narrative Review.

Perinatal depression is more prevalent in low- and middle-income countries (LMICs) than in high-income countries, reflecting greater exposure to physical, psychosocial, and environmental adversities. It can have lasting consequences for the woman, her child, and wider family. Despite its high burden, access to appropriate mental health care for perinatal depression remains extremely limited in most LMICs. In this narrative review, we conducted a search of PubMed and Google Scholar from 2015 to 2024 (with the addition of other key articles based on authorship team consensus) for recent and policy-relevant systematic reviews, meta-analyses, key individual studies, and practice guidelines to provide an overview of identification, treatment, and prevention of perinatal depression in LMICs. Regarding identification, brief screening measures have been adapted and validated in LMICs, but there have been few studies testing the feasibility and effectiveness of screening programs. Cognitive behavioral therapy and interpersonal therapy have demonstrated effectiveness for perinatal depression in meta-analyses that include LMIC studies, particularly when adapted into brief, structured formats and delivered by nonspecialist providers through task-sharing models. Regarding prevention, evidence from a range of studies supports universal delivery of low-intensity psychosocial interventions during routine perinatal care and psychological interventions for women with elevated symptoms or known risk factors. Multiple barriers to implementation of effective perinatal depression interventions at scale in LMICs remain, including financial and human resource constraints, high service user to provider ratios, and underdeveloped referral pathways. Responses include delivery of interventions by peers rather than health workers and use of digital technologies.